Sollid Department of Neurosurgery, University Hospital of North Norway, 9038 Troms, Norway e-mail: snorre. Commonly, the initial clinical presentation is unspecic. This is an important consensus statement built from European and particularly Scandinavian strategies. Women had lower scores on Role-Physical, Bodily Pain more pain and General Health. With greater transfer distances, injury severity increased, and there were larger proportions of traffic injuries, polytrauma and hypotensive patients. Participants A total of 93 patients participated in the 5-year follow-up. Finally, neurosurgical intervention was defined as any neurosurgical procedure for a cranial or intracranial injury within the first week following trauma.
Restoration of nitrogen balance is often not achieved until 23 weeks after the injury. Any medical therapy of these patients may be affected by infections, as altered hemo- dynamics affects pharmacokinetics, and the risk of drug interactions will increase upon initiation of treatment with selected antimicrobials in severe infections. Most of them are not treat- able due to the severity of the traumatic lesions. Further, serum pre-albumin concentrations were signicantly higher in the zinc-supplemented group 3 weeks after injury, which might indicate better nutritional status Young et al. Additional file 3: Table S3. Risk factors such as intoxication, trauma above the clavicles, nausea, vertigo and headache were not included due to poor predictive ability combined with a high prevalence of these factors in the head injury population. Without you, this book project would not have been possible.
There is a difference in the cause of injury between the ages. Implementation and monitoring strategies were discussed within the working group in order to facilitate long-term successful use of the guidelines in Scandinavia. The evidence was sparse and also of low quality due to study limitations selection bias and inconsistency in findings. In both cases, aminoglycosides can be considered in combination. About 200 per 100,000 inhabitants are each year admitted to hospital with a head injury Ingebrigtsen et al. Proportion of patients with poor outcomes fell from 34% to 19%.
The use of computed tomography in the management of patients with mild head injury is feasible and leads to similar clinical outcomes compared with observation in hospital. Simultaneously, the guidelines were evaluated by important stakeholders from specialties directly involved in the everyday management of these patients. Few studies have addressed transferred trauma patients. However, the interest to be charged by the bank will be passed on to you as an upfront discount. Due to the increasing number of motor vehicles in densely populated regions, it is estimated that trauma will become the fourth most common cause of death within 2020 Murray and Lopez 1997. This approach should also stratify reference standards in a more homogenous selection compared to a combined definition. Evidence-based management of minimal, mild and moderate head injuries.
This book is a practical, comprehensive guide to the treatment of patients both adults and children with such injuries, from the time of initial contact through to the rehabilitation center. Immediate computed tomography or admission for observation. Supplementation of amino acids is necessary to maintain protein syntheses. Many patients in the neurointensive care unit are monitored or treated with indwelling ventriculostomy cathe- ters. Ugeskr Laeger 162:3839—3845 Romner B, Ingebrigtsen T, Kock-Jensen C 2000b Scandinavian guidelines for manage- ment of head injuries. Prevention has the highest impact on trauma death. Crit Care Med 26:15291535 Kansagara D, Fu R, Freeman M, Wolf F, Helfand M 2011 Intensive insulin therapy in hospitalized patients: a sys- tematic review.
Despite this, it is important not to feed too much energy, eventually causing obesity, which has negative effects for the daily care of the patient. Therefore, consensus was achieved to address two important clinical questions that would require systematic review of evidence and would form the basis of the updated guidelines, shown below. A direct trauma to the orbit may do the same. Department of Neurosurgery Aarhus University Hospital Aarhus C Denmark Bertil Romner, M. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publishers location, in its cur- rent version, and permission for use must always be obtained from Springer.
To compare immediate computed tomography during triage for admission with observation in hospital in patients with mild head injury. Tidsskr Nor Laegeforen 120:1985—1990 Ingebrigtsen T, Romner B, Kock-Jensen C 2000b Scandinavian guidelines for initial management of minimal, mild, and moderate head injuries. Because of this, trauma is a major health prob- lem, which emphasises the importance of both prevention and treatment. It becomes particularly relevant in poor resource, developing countries, where health care facilities and access to specialized care units are still far below the acceptable standard, there is a need to compare with the reference group to further support the evidence. Clinical stakeholders were involved in later processes of guideline approval, see main text. Mller prophylactic antimicrobial therapy, either peripro- cedural or for the duration of the drainage period. Level I evidence: Properly designed prospective randomized controlled trial the gold standard of clinical practice.
Feedback was documented and appropriate changes were made, if necessary, but only to consensus aspects. A flow chart for clinical decision making and a Head Injury Instruction card are introduced. J Trauma 65:1488—1493 Sundstrøm T, Sollid S, Wentzel-Larsen T, Wester K 2007 Head injury mortality in the Nordic countries. Printed on acid-free paper Springer is part of Springer Science+Business Media www. There were a number of significant injury-related and demographic predictors across the four trajectories of physical health.